Articles: emergency-department.
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Some patients with acute pulmonary embolism (PE) will suffer adverse clinical outcomes despite being low risk by clinical decision rules. Emergency physician decisionmaking processes regarding which low-risk patients require hospitalization are unclear. Higher heart rate (HR) or embolic burden may increase short-term mortality risk, and we hypothesized that these variables would be associated with an increased likelihood of hospitalization for patients designated as low risk by the PE Severity Index. ⋯ Most patients were hospitalized, often with recognizable high-risk characteristics not accounted for by the PE Severity Index. Highest ED HR of ≥90 beats/min and bilateral PE were associated with a physician's decision for hospitalization.
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Multicenter Study
Subcutaneous Insulin Versus Traditional Intravenous Insulin Infusion in Treatment of Mild to Moderate Diabetic Ketoacidosis.
Intravenous (IV) insulin infusions are the current standard of care for treatment of diabetic ketoacidosis (DKA). Subcutaneous (SQ) insulin, however, may also be a safe and effective alternative. ⋯ SQ insulin may be an effective alternative option for treating mild to moderate DKA with fewer hypoglycemic effects.
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Emergency department (ED) utilization is a significant concern in many countries, but few population-based studies have compared ED use. Our objective was to compare ED utilization in New York (United States), Ontario (Canada), and New Zealand (NZ). ⋯ Patterns of ED utilization differed widely across three high-income countries. These differences highlight the varying approaches that our countries take with respect to urgent visits, suggest opportunities for shared learning through international comparisons, and raise important questions about optimal approaches for all countries.
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The first 2 years of the COVID-19 pandemic brought substantial and dynamic changes to emergency department volumes and throughput. The objective of this study was to describe changes in ED boarding among US academic EDs across the duration of the COVID-19 pandemic. ⋯ A sustained and considerable increase in boarding observed in selected US academic EDs during later phases of the COVID-19 pandemic may reflect ongoing stresses to the health care system, with potential consequences for patient outcomes as well as clinician well-being.
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Pediatric emergency care · Sep 2023
Nighttime Sedations in the Pediatric Emergency Department: A Single-Center Experience.
Procedural sedation and analgesia (PSA) is the standard of care for many procedures in the pediatric emergency department (PED). Although generally performed by skilled PED physicians, in Israeli PEDs, during nighttime hours, it is mainly performed by pediatric residents. The safety of PSA by residents is considered comparable yet has not been evaluated regarding nighttime performance. ⋯ Sedations performed during nighttime hours by pediatric residents seem safe and effective. This should strengthen the empowerment of residents to perform sedations when necessary even at late hours of the night. Recognizing cases at higher risk may avoid possible AEs.